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may result in forfeiture of contractual payments, <br />I hereby affirm under the penalties of perjury that the facts and information contained in the foregoing bid <br />for public works are true and correct. <br />Dated this 2 4 t h dayof SepteTper, 2019 <br />Larson Danielson Const. Cc., Inc. <br />Contractor/Bidder (Firm <br />LARSON DANIELSON X > <br />CONSTRUCTION CO,, INC. Signature of Contractor1XW4WX 1 <br />Timothy F . Larson, President <br />Subscribed and sworn to before me this 2 4 t h <br />My Commission Expires <br />9/8/23 <br />County of Residence <br />Printed Name and Title <br />day of September20 2019 <br />Notary Public Michele C . Dzielinski <br />LaPorte <br />MICHELE CECELIA DZIELINSKI <br />a���r���l <br />Ewa <br />LaPodeCounty <br />My Commission Expires <br />C ,�� SoI��pJv�t7�C B, 2023 <br />w <br />Version 4/2/2019 Contractor's Bid for Public Works - 6 <br />